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Concept Researcher Analyst - Frankfort KY or Telecommute

Frankfort, KY

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Concept Researcher Analyst - Frankfort, KY or Telecommute

Job #714786435
Here's the thing about challenges. They provide limitless opportunities for greatness. And what we have in mind for you is definitely big. At **MEMBERS ONLY**SIGN UP NOW***., we're changing the future of health care and we have the expertise, advanced technology and global resources to make it happen. As a Senior Business Analyst, you'll work with the brightest minds in the business and find yourself digging deep to find the solutions to help people live healthier lives. You'll be responsible for analyzing, reviewing and forecasting data for operational and business planning to impact the health care system. What could be more satisfying than that? Join us!
This position will support current and future Commercial PI engagements with new medical cost savings opportunity development. It's being opened to support anticipated Commercial PI growth based on the current sales pipeline. The resource will be responsible for analyzing health plan and government sponsored health program policies and contracts, ideating new savings concepts, and coordinating with Analytics and Operations teams to ensure solutions deploy appropriately in pursuit of client savings commitments. The job requires the interpretation of policies into analytic concepts, translation of concepts to data requirements, establishing strong client relationships, and the development of proposals to justify new opportunity pursuit to clients. While biasing to the external market, this resource will support United PI activities as capacity allows.
The Concept Researcher Analyst
position requires a strong analytical skillset, data analysis and healthcare claims expertise (HCFA / UB) to detect incorrectly paid claims for multiple segments (Medicare, Medicaid and Commercial) and claim platforms. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Researching and developing potential claim overpayment hypotheses
Responsible for utilizing data mining tools (i.e. SQL, Access, Excel) in order to analyze data to support of their hypothesis
Running initial PL SQL queries to ensure hypothesis is worth developing further
Researching policies, coding guidelines, and regulations that would support the hypothesis being developed
Filling out Business Requirement Documentation in a clear, concise, and comprehensive manner
Flexibility and ability to handle multiple priorities at the same time
Clearly communicate concept to business partners/clients and be able to appropriately respond to question relating to the logic utilized within hypothesis testing, documentation, and the analytic
Performing quality checks for claim overpayment hypothesis results
When opportunity is confirmed, the analyst will present the findings for solution approval in a clear and concise manner utilizing data reports and summaries to support their concept
An understanding of healthcare payment methodologies, policies, and coding are necessary
Required Qualifications:
2 years of experience in healthcare (billing, coding, auditing claims)
2 years of experience with data analysis
2 years of experience with claims processing or adjudication systems (Such as UNET, COSMOS, Facets, Diamond, etc. or provider billing / coding knowledge on Professional and Facility claims)
Working knowledge of coding standards, billing rules and regulations and knowledge of procedure and diagnosis codes (CPT, ICD10 coding, HCPCS, APC and DRGs)
Strong computer skills: MS Excel, Word, PowerPoint
Typing speed of at least 50 WPM including ten-key
6 months of experience with SQL or PL SQL
Knowledge of Medicare, Medicaid and/or commercial health plan and payment methodology
Proficiency with SQL coding and ability to run test queries to ensure viability of concepts under review
Preferred Qualifications:
Bachelor’s degree or equivalent experience
Advanced degree in health care or medical field
Technical Writing and/or Business Requirement Documentation experience
Microsoft Access proficiency
Coding certification through AAPC or AHIMA
Knowledge of statistical methods used in the evaluation of healthcare claims data
Excellent critical thinking and problem solving skills
Exceptional communication and negotiation skills
Ability to identify payment errors regardless of the claim system by reviewing data and possessing claims coding experience
Ability to think outside of the box
Ability to breakdown a complex problem into individual root causes
Self-starter with the ability to support multiple concurrent projects and meet delivery timelines
Careers with Optum.
Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the **MEMBERS ONLY**SIGN UP NOW***. family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
*All Telecommuters will be required to adhere to **MEMBERS ONLY**SIGN UP NOW***.’s Telecommuter Policy.
Diversity creates a healthier atmosphere: **MEMBERS ONLY**SIGN UP NOW***. is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
**MEMBERS ONLY**SIGN UP NOW***. is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: Concept Researcher Analyst, Analyst, Research, Medicaid, Government, SQL, MS Office, Data Analysis, Frankfurt, KY, Kentucky, Telecommute, Remote, Work from home
Updated 08/11/2018

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